Isolated Plexiform Neurofibroma of the Nasal Tip - A Rare Case Report

A 28-year-old female patient presented at ENT OPD with complaints of a slowly growing mass over nasal tip since last 5 years. There were no complaints of pain, nasal obstruction, or epistaxis. There were no skin changes or ulceration over the swelling and sensation was preserved. There was no history of similar kind of swelling in other parts of the body. History of trauma or any form of surgical intervention were excluded. Family history was insignificant. The swelling did not respond to any medications. The patient attended for cosmetic reason solely. Clinical examination showed a soft non-tender 4 cm by 4 cm mass over nasal tip and supratip area. Mobility of the mass was restricted and fixed to the alar cartilages. There was no evidence of café au lait spots or any other skin lesions. Anterior rhinoscopy was unremarkable. Diagnostic nasal endoscopy was also performed but no abnormality was detected. CT scan showed non-specific infiltrative subcutaneous lesions. T1W MRI showed an ill-defined hypodense mass over the nasal tip which was abutting the alar cartilages which showed mild enhancement with contrast (figure 1). T2W MRI showed hyperintense and or hypodense central focus (target sign). FNAC was done and report was suggestive of neurogenic tumour, most probably neurofibroma.

A clinical study on linear dermatoses at a teriary care teaching hospital in Davangere

<p class="abstract"><strong>Background:</strong> Skin lesions present with innumerable patterns like discoid, petaloid, arcuate, annular, polycyclic, livedo, reticulate, target, stellate, digitate, linear, serpiginous and whorled. Most of the linear lesions follow the Blaschko’s lines. Aim was to study the incidence of linear dermatoses, the age and sex incidence, various types of clinical presentation, various sites of distribution and their clinical correlation. </p><p class="abstract"><strong>Methods:</strong> Detailed history including family history, History of disease documented with clinical examination. After counselling and after recording their consent for the test, skin biopsy along with routine investigations was done wherever needed and the results were evaluated. <strong></strong></p><p class="abstract"><strong>Results:</strong> Lichen striatus was seen in 29.91% followed by linear herpes zoster in 24.7%, linear lichen planus in 18.22%, linear verrucous epidermal nevus in 14.01%, segmental vitiligo in 3.73%, nevus depigmentation in 2.33% and others. Maximal cases were asymptomatic and reported for cosmetic reason. Intense itching was the main reason to bring the lichen planus patients and few cases of the lichen striatus patients for treatment. </p><p class="abstract"><strong>Conclusions:</strong> Lichen striatus was found to be more common, female preponderance. Majority of patients showed unilateral distribution more on the extremities. Histopathological correlation shows the importance of histopathology which ultimately changes the management in any given condition.</p><p> </p>

Verrucous Carcinoma in a Giant Cutaneous Horn: A Case Report and Literature Review

Background. A cutaneous horn is a common clinical entity which usually presents as a cutaneous lesion. Because of its subtle nature, patients usually tend to present late unless the lesion is big or complications develop. Because of its resemblance to animal horn, it has been given the term “horn.” Cutaneous horn seems to have a remarkable history. Though cutaneous horn is benign most of the times, chances of malignancy (20–25%) should be kept in mind. Old age, giant cutaneous horn carries more chances of transformation into malignancy like in our case. Thus, early diagnosis and treatment is required in all cases. Case Presentation. We report a case of a 74-year-old farmer with a cutaneous projection measuring ∼8 × 5 × 3 cm3 over the medial surface of the right pinna for 1 year. It started as a small projection which was progressively enlarging. The primary reason behind him presenting to us was cosmetic reason since it resembled an animal horn. The projection was not associated with pain or similar lesions anywhere else in body. Understanding the malignancy risks and the cosmetic benefits, he was planned for excision biopsy of the horn. He had no systemic signs of malignancy. Histopathological reports were consistent with malignancy. Conclusions. Cutaneous horns are usually benign lesions and mostly found in the head and neck region. Because of the chances of malignancy, cutaneous horns should undergo surgical removal and biopsy for early and definitive diagnosis and management.

Multiple clustered dermatofibroma associated with asymptomatic pericardial cyst

<p>Multiple clustered dermatofibroma (MCDF) is an unusual variant of dermatofibroma (DF) presentation, localized on one segment of the body. Multiple dermatofibroma is a term for when there are more than 15 dermatofibromas, which in itself is already a rare condition. The dermatofibromas usually appear in younger adults and are predominantly located on lower parts of the body. No associations, except one case with pulmonary hypertension, were described in patients with MCDF. Herein we present another case of this rare complaint in a 58 year old female with clustered lesions on the thigh. Pericardial cyst was identified in our patient during routine chest X-ray and the patient is asymptomatic. MCDFs do not usually require treatment unless requested by the patient for cosmetic reason. This variant of MCDF, which is neither congenital nor eruptive, is extraordinarily rare, with only 13 cases reported. Further reports may identify possible associations of MCDF.</p>

Cubitus varus in adults correction with lateral closing wedge osteotomy and fixation with posterior plating

To share the result of lateral closing wedge osteotomy and fixation with posterior reconstruction plate in correction of cubitus varus in adults. It is a retrospective case analysis of 8 cases of cubitus varus in adult treated with lateral closing wedge osteotomy through posterior triceps retracting approach. Internal fixation was done with two posterior reconstruction plates. All cases were from 15 to 29 years of age (mean 22.3 ) with 3 female and 5 male. All had cubitus varus ranging from 15- 28 deg (mean 20.16 deg) due to childhood malunited supracondylar fracture of humerus. Indication for operation was cosmetic reason only. Follow up duration was 4-22 months (mean 12.5 months). All the osteotomy united clinically in mean duration of 9 weeks ( range 8-12 weeks) with mean carrying angle 8.33 degree in postoperative phase. There was no loss of motion, no loss of fixation, no surgical site infection, nonunion or neurovascular deficit. Lateral closing wedge corrective osteotomy and fixation with posterior reconstruction plate is easy technique with satisfactory result in correction of cubitus varus in adults. Journal of College of Medical Sciences-Nepal,2012,Vol-8,No-2, 49-53 DOI: http://dx.doi.org/10.3126/jcmsn.v8i2.6839

Compliance with compression stockings in patients with chronic venous disorders

Objective The aim of this large survey was to evaluate non-compliance with compression stockings in chronic venous disorder (CVD) patients. Method A total of 16,770 CVD patients participated in this study. Results Compression stockings were used by 25.6% of CVD patients and 46.6% of the patients were never prescribed compression therapy. Compression stocking use was found to increase with the clinical stage of CVD. The percentage of patients using compression stockings during control visits increased to 37.4%. Furthermore, 5.3% of the patients coming to control visits discontinued the use of compression stockings owing to high cost, sweating, itching, cosmetic reason, oedema exacerbation, exudation lesions of lower legs and application difficulty. Past episodes of vein thrombosis (OR = 0.80), of stroke (OR = 0.28) and of varicose veins surgery (OR = 0.28) were decreasing, while the management by a general practitioner was increasing the risk (OR = 1.36) of compression therapy cessation. Conclusion (1) Compression stockings are too rarely prescribed and often unaccepted at early stages of CVD; (2) The common reason for discontinuation of compression therapy is its high cost.

Surgical Management of a Rare Case of Congenital DoubleUpper Lip

Congenital double lip is a rare developmental anomaly which usually involves the upper lip. It may occur in isolation or as a part of Ascher's syndrome. The occurrence of double lip may result in facial deformity especially when patient attempts to talk, smile, or even try to show the teeth. It affects esthetics and also interferes with speech and mastication. Although surgery may be undertaken to facilitate speech and mastication, majority of cases are operated for cosmetic reasons. A case of congenital double upper lip which was surgically treated for cosmetic reason is reported.

Tumour and tumour-like conditions of peripheral nerve origin: Ten years’ experience

Background: There are four major lesions which may arise in the peripheral nerve, namely neuroma, schwannoma, neurofibroma and malignant peripheral nerve sheath tumor. Objective: In the present study we look into the spectrum of peripheral neural tumors including their age distribution site distribution and histopathology. Materials and methods: This is retrospective study conducted in the Dept of Pathology, Manipal Teaching Hospital, Pokhara. All histopathologically diagnosed cases of primary lesions of peripheral nerve during the period Jan 2000 to Nov 2009 were reviewed and the data were analysed. Result: A total of 114 cases of peripheral neural lesions were reported in the same period. Total number of nonmalignant cases was 106 (93%) while malignant cases were 8 (7%). Among the nonmalignant cases neurofiboma was the commonest (51 cases, 45% of all) closely followed by schwannoma (39 cases, 34% of all). Among the neurofibroma cases only 2 cases had multiple neurofibromatosis while others were solitary. Among the schwannoma cases 4 were diagnosed as ancient schwannoma with presence of bizarre cells with hyperchromatic nuclei. The commonest site involved for both schwannoma and neurofibroma was scalp-face-neck followed by back. The age range for schwannoma was 16 to 75 years whereas the same for the neurofibroma cases was 2 to 82 years. MPNST cases were seen in the age range of 40 to 72 with 3 cases in upper extremity, 3 in lower extremity and 1 each in lip and cheek. 1 case was diagnosed as cellular neurofibroma with atypia in tongue and was confirmed by S100. Conclusion The majority of the tumor are benign and the commonest benign tumor was neurofibroma of sporadic type, closely followed by schwannoma. In our study the commonest site was scalp-face-neck unlike other studies. This may be due to more compliance of the patients due to cosmetic reason. ey words : Malignant peripheral nerve sheath tumor; Neurofibroma; Peripheral nerve; Schwannoma DOI: 10.3126/kumj.v8i1.3231 Kathmandu University Medical Journal (2010), Vol. 8, No. 1, Issue 29, 97-101